Strains

A strain develops as a result of an abnormal spinal movement as in cases of traumatic injuries or overuse/misuse. The injury can be caused by stretching, tearing or rupture of muscles in the area of pain. The majority of back patients presenting to general specialty physicians have this diagnosis. The symptoms may last 2-6 weeks and the symptoms are treated conservatively without any surgery. Since the lumbar (low back) area is very mobile, it is prone to this type of injury. Improper lifting techniques are another cause of lumbar strain. For this reason we recommend lifting objects by bending the knees rather than bending the spine. Furthermore, the object should be kept close to the body rather than away from the body. To accomplish this, the legs should be kept apart and the object could be held between the legs. Measurements taken when the object is close to the body show much decreased stress on spinal musculature. Other causes are forceful twisting or usual motions. Conditioned muscles can resist injury and withstand higher stress.

Traumatic events such as Motor Vehicle Accidents (MVA’s) could also elicit this process as well. As with any other disease, the diagnosis may not be certain and it could be confused with a Herniated Disc.

Symptoms usually resolve within 2 weeks and include:

Pain is the hallmark of a lumbar strain and could be felt over a broad area. The pain is present on the sides of the bony prominence, in the muscular regions.

Patients may describe a “knot” in their back which represents muscle spasm.

There is no radiation of pain into other areas. However the pain may be felt in the buttocks area. This pain does not radiate into the extremity as commonly seen with a Herniated Disc.

Stiffness is also common as the back musculature is in spasm. Daily activities may be very painful during the initial days after injury.

The strained area may be warm, swollen and tender.

Consult our office is any of the following persist or present: Pain and symptoms lasting more than 2 weeks. Unexplained symptoms such as increased pain, or development of weakness. Any numbness, tingling, weakness, or pain in the extremities should be brought to our attention for further workup.

An orthopedic spine surgeon will conduct a detailed orthopedic history and physical examination. This may confirm the diagnosis of a lumbar strain or may reveal other diagnosis as well. The exam typically will include measurement of motor strength, sensory and nerve function or presence of abnormal reflexes. Your spine surgeon will use his knowledge of the disease process, associated pathophysiology, and experience to determine if further studies are needed for accurate diagnosis. These studies may include X-rays, MRI, EMG’s, or even Myelography.

Treatment Options:

If you have been diagnosed with a lumbar strain, your symptoms should last only two weeks. Generally, the first 2 days are the most painful and functional capacity should return within 2 days. The pain however, will decrease but not completely resolve. Research studies repeatedly proved that rest for more than 2 days are not beneficial and may even hinder the recovery process. Likewise, medications such as muscle relaxants, should be limited to 2 days since their efficacy has not been proven in research studies. Narcotic medications should also be used sparingly after the first 2 days. After that initial period, anti-inflammatory medication can be used to control residual symptoms. In cases of sever strain a physical therapy program may be prescribed to increase muscular endurance and power. Information gathered from clinical studies has shown that men will benefit from endurance training and women benefit from strength training. This may be due to the inherent quality of men and women. Men traditionally acquire stronger musculature due to hormonal differences between men and women.

Lumbo-Sacral corset or supports may be prescribed to maintain alignment and provide support. This may help in the recovery period and return the patient to functional life style. These supports however should not be used for long periods as they de-condition spinal muscles since they rely on the corset for stability and balance.

Another common treatment is the contrast therapy. Cold pack is applied which reduces inflammation and anesthetizes nerve endings. This is followed by hot pack which increases blood flow to the area. Heat will also restore flexibility, relieve muscle cramping, and arthritic symptoms. The mechanism of action is still not proven but clinical studies have shown that this regime may expedite recover. At this time this treatment is supported only by observational reports since its mechanism of action is not proven.

Chiropractic and acupuncture have the same role. Their mechanism of actions are still not proven but only theorized. Even though their mechanism of action is questionable, some patient report relief from the perceived pain and so the benefit of chiropractic and acupuncture is supported by observational reports only.

These are the positions recommended to relieve back pain. Use a pillow to bend your knees and your hip. This will reduce the tension on your ligaments and nerves passing through and connected to the back.

To avoid strains don’t lift by bending your back. Instead, bend your hips and knees. Keep your back straight, spread your knees so that the object could be held close to your body between your legs. The closer the object is held to your body, the lesser the stress on your back musculature and ligaments. Research studies have shown that the optimal sitting position is at 110º degrees and not the customary 90º. Imagine sitting in a recliner as opposed to a rigid 90º chair. Disc pressures muscle tension is lower at 110º. Pushing is biomechanically less stressful than pulling. Flat shoes are beneficial rather than heeled shows more than 1 inch. Try using a lumbar roll when sitting. This will maintain proper posture decreasing muscle tension and pain.

If you are suffering from back pain please contact our office for a consultation and treatment. Our friendly staff will guide and support you through out your recovery period. Our goal is fast and swift functional recovery and return to normal, full functional capacity.